發(fā)布時(shí)間：2018-07-08 13:49

  本文選題：法醫(yī)病理學(xué) + TSAH��； 參考：《汕頭大學(xué)》2010年碩士論文

【摘要】： 背景與目的 外傷性蛛網(wǎng)膜下腔出血(traumatic subarachnoid haemorrhage,TSAH)是一種不同于腦挫傷所致的蛛網(wǎng)膜下腔出血和病理性蛛網(wǎng)膜下腔出血的獨(dú)立蛛網(wǎng)膜下腔出血,與外傷性硬腦膜外出血、硬腦膜下腔出血并列為三大外傷性顱內(nèi)腔隙出血。國(guó)內(nèi)外學(xué)者報(bào)道的TSAH常與酗酒有關(guān),但其發(fā)生及死亡機(jī)制的研究性報(bào)道較少見。因此,探討和闡釋急慢性酒精中毒相關(guān)的TSAH發(fā)生及死亡機(jī)制,可為其死因分析、司法審判量刑提供科學(xué)的理論依據(jù)。 本課題組前期工作已成功地建立了大鼠急慢性酒精中毒TSAH模型,結(jié)果顯示,腦震蕩性輕微外力打擊灌酒后大鼠的TSAH發(fā)生率:慢性組82.4�j、急性組28.6%,死亡率:慢性組58.8�j、急性組0�j,慢性灌酒組TSAH發(fā)生率及死亡率遠(yuǎn)大于急性灌酒組。并從MMP-9血管壁毒性物質(zhì)、血管壁形態(tài)結(jié)構(gòu)及其生物力學(xué),Ngb、Hif-1α、EPO、Na~+,K~+-ATPase等腦氧和能量代謝物,tPA、Cyt-C、Caspase-9、Caspase-3、Bcl-2、Bax等細(xì)胞凋亡相關(guān)物質(zhì),證實(shí)了酒精的綜合性毒理學(xué)作用在TSAH發(fā)生及死亡機(jī)制中具有重要作用。 本實(shí)驗(yàn)是在此基礎(chǔ)上,進(jìn)一步探討慢性灌酒大鼠TSAH高死亡率與膠質(zhì)細(xì)胞改變的關(guān)系,選擇與中樞神經(jīng)纖維功能結(jié)構(gòu)密切相關(guān)的膠質(zhì)細(xì)胞特異性標(biāo)志物S-100β、MBP,探討急慢性酒精中毒情況下腦組織S-100β、MBP的表達(dá),及其與大鼠TSAH死亡機(jī)制的相關(guān)性。 材料與方法 1動(dòng)物模型及分組 SPF級(jí)成年雄性SD大鼠61只,體重300±50g,分籠適應(yīng)性飼養(yǎng)2周,隨機(jī)分組。 1.1急性灌酒模型 28只大鼠隨機(jī)分急性單純灌酒組、急性灌酒打擊組、急性單純灌水組、灌水打擊組共4組,每組7只。灌酒組一次性白酒(北京紅星酒廠二鍋頭,52%v/v)灌胃15ml/kg;灌水組同等劑量的食用水灌胃。打擊組在灌白酒或食用水后2h,給予腦震蕩性打擊。 1.2慢性灌酒模型 33只大鼠隨機(jī)分為慢性單純灌酒組7只、慢性灌酒停酒打擊組7只、慢性灌酒打擊組19只(其中死亡10只歸為死亡組,存活9只歸為存活組)共4組。各組大鼠給予白酒灌胃(北京紅星酒廠二鍋頭,52%v/v),一天兩次,間隔8小時(shí),前2周每次予灌胃劑量8ml/kg、后2周每次灌胃劑量予12ml/kg,最后一次灌酒后2h,慢性灌酒停酒打擊組于灌酒后12h,給予腦震蕩性打擊。 2方法 各灌酒打擊和灌水打擊組大鼠予腦震蕩打擊后,放置4h予乙醚麻醉,開胸左心室取血5ml,死亡的大鼠立即開胸取血5ml,經(jīng)左心室-主動(dòng)脈插管,灌注4%中性多聚甲醛液處死兼固定腦組織,開顱取全腦,置于4%中性多聚甲醛固定、取材,常規(guī)石蠟包埋、HE切片染色,固綠(Fast green)髓鞘染色觀察腦組織及髓鞘組織形態(tài)學(xué),S-100β、MBP免疫組化染色,Image-Pro Plus 6.0圖像分析軟件體視學(xué)量化組織病理學(xué)觀測(cè),BAC檢測(cè)。所有數(shù)據(jù)均應(yīng)用SPSS15.0統(tǒng)計(jì)軟件,t檢驗(yàn)和單因素方差、卡方檢驗(yàn)統(tǒng)計(jì)分析。 結(jié)果 1急慢性酒精中毒大鼠行為學(xué)表現(xiàn)和BAC變化 急性灌酒組大鼠灌酒后0.5h內(nèi)活動(dòng)增多、不停張望,呈興奮狀態(tài),之后活動(dòng)減少、步態(tài)不穩(wěn)、動(dòng)作笨拙,呈昏睡、呼吸緩慢,反應(yīng)遲鈍等醉酒表現(xiàn)。灌酒后2h血酒精濃度(BAC)180.16±16.58 mg/dL、血壓14.13±0.34 Kpa,較灌酒前血壓17.02±0.88 Kpa顯著下降(P0.01);灌水組灌胃后行為及血壓均無明顯變化(P0.05)。 慢性灌酒組大鼠灌酒期間,逐漸出現(xiàn)消瘦、營(yíng)養(yǎng)不良、進(jìn)食減少,精神萎靡、部分一側(cè)肢體偏癱等慢性酒精中毒改變,4w后體重251.8±19.6g較灌胃前307.2±28.9g明顯下降(P0.01)、血壓18.16±0.82Kpa較灌胃前16.60±0.76Kpa明顯增高(P0.01)。灌酒后0.5h內(nèi)呈側(cè)臥、昏睡、翻正反射消失等急性酒精中毒表現(xiàn),最后一次灌酒2h后BAC 208.50±32.35 mg/dL高于急性組。 2 TSAH發(fā)生率、死亡率及病理學(xué)觀察 急性灌酒打擊組大鼠TSAH發(fā)生率為28.6%,無死亡,灌水打擊組未見TSAH發(fā)生及死亡;慢性灌酒打擊組的TSAH發(fā)生率為84.2%、死亡率52.6%,慢性灌酒停酒打擊組的TSAH發(fā)生率為71.4%、死亡率28.6%,死亡率較慢性灌酒打擊組有顯著差異(P0.01)。 急性單純灌水組大腦表面散在局限性淤血;急性灌水打擊組大鼠腦表面光滑,呈蠟樣蒼白;急性單純灌酒組大鼠額葉及小腦表面大片淤血;急性灌酒打擊組發(fā)生TSAH的大鼠腦表面及腦干背側(cè)、腹側(cè)斑片狀薄層SAH;慢性灌酒打擊組發(fā)生TSAH的大鼠全腦彌漫厚層SAH,以腦干腹側(cè)面為重。 組織學(xué)檢查,急性灌酒組腦神經(jīng)元及神經(jīng)膠質(zhì)細(xì)胞輕度水變性、細(xì)胞周隙輕度擴(kuò)大,打擊組腦干及小腦薄層SAH。慢性灌酒組腦皮質(zhì)各層神經(jīng)元排列紊亂、數(shù)目減少、核固縮,多見噬神經(jīng)現(xiàn)象;小腦蒲肯野細(xì)胞疏松較少、胞體三角形固縮變小、突起減少、核固縮深染,部分溶解消失;延腦多見均質(zhì)化胞漿深染固縮、核固縮的暗神經(jīng)元(Dark cell);打擊組腦干、額頂、小腦等處大片厚層SAH。 固綠髓鞘染色(髓鞘呈深綠色、細(xì)胞核呈紅色),急性單純灌水組腦干、胼胝體及小腦神經(jīng)纖維髓鞘平直、排列緊密;急性灌酒打擊組的髓鞘排列稍疏松、間隙大,著色稍淡;慢性打擊組的髓鞘疏松、間隙增大,著色淺淡不均,腦干可見明顯不規(guī)則增粗扭曲、斷裂神經(jīng)纖維,周隙明顯擴(kuò)大。 3 S-100β蛋白、MBP的表達(dá) 3.1 S-100β蛋白陽(yáng)性細(xì)胞數(shù) 急性灌酒打擊組和灌水打擊組大鼠各腦區(qū)S-100β陽(yáng)性細(xì)胞數(shù)均顯著多于急性灌酒和急性單純灌水組(P0.05);打擊組之間、單純組之間均無統(tǒng)計(jì)學(xué)差異(P0.05)。慢性灌酒打擊存活組和慢性灌酒停酒打擊存活組大鼠各腦區(qū)陽(yáng)性細(xì)胞數(shù)均顯著多于慢性單純灌酒組和慢性灌酒打擊死亡組(P0.05);慢性灌酒打擊存活組和慢性灌酒停酒打擊存活組之間、慢性單純灌酒組和慢性灌酒打擊死亡組之間均無顯著差異(P0.05)。 慢性灌酒打擊存活組和慢性灌酒停酒打擊存活組大鼠各腦區(qū)陽(yáng)性細(xì)胞數(shù)均顯著多于各急性組(P0.05);慢性單純灌酒組和慢性灌酒打擊死亡組各腦區(qū)陽(yáng)性細(xì)胞數(shù)均多于各急性單純灌酒和急性單純灌水組(P0.05),與急性灌酒打擊組和灌水打擊組無顯著差異(P0.05)。 3.2 S-100β蛋白IOD值 急性灌酒打擊組和灌水打擊組各腦區(qū)S-100βIOD值均高于急性單純灌酒組和急性單純灌水組(P0.05),打擊組之間、單純組之間無統(tǒng)計(jì)學(xué)差異(P0.05)。 慢性單純灌酒組的IOD值最高,均顯著高于其它慢性灌酒組(P0.05);慢性灌酒打擊死亡組的IOD值最低,均顯著低于其它慢性灌酒組(P0.05);慢性灌酒打擊存活組與慢性灌酒停酒打擊存活組的IOD值無顯著差異(P0.05)。 除慢性灌酒打擊死亡組以外,其它慢性灌酒組的IOD值均高于急性組;慢性灌酒打擊死亡組的IOD值與急性灌酒打擊和灌水打擊組無顯著差異(P0.05),高于急性灌酒和急性單純灌水組(P0.05)。 3.3 MBPIOD值 急性灌酒打擊組和急性灌水打擊組腦干和胼胝體MBP IOD值均顯著低于單純灌酒和單純灌水組(P0.05),打擊組之間、單純組之間無統(tǒng)計(jì)學(xué)差異(P0.05);小腦各組間均無顯著差異(P0.05)。 慢性單純灌酒組各腦區(qū)MBP IOD值最高,高于其它各慢性灌酒打擊組(P0.05);各慢性灌酒打擊組之間胼胝體及小腦MBP IOD值無顯著差異(P0.05);慢性灌酒打擊死亡組腦干MBP IOD值高于慢性灌酒打擊存活組及慢性灌酒停酒打擊存活組(P0.05),存活組之間無顯著差異(P0.05)。除慢性單純灌酒組與急性打擊組大鼠各腦區(qū)MBP IOD值無顯著差異外(P0.05),慢性灌酒組各腦區(qū)MBPIOD值均低于急性組(P0.05)。 結(jié)論 1、急慢性酗酒均可協(xié)同腦震蕩性打擊促發(fā)TSAH,慢性酗酒是TSAH死亡重要因素。 2、慢性酒精中毒腦組織膠質(zhì)細(xì)胞S-100β蛋白表達(dá)增強(qiáng)、神經(jīng)纖維髓鞘MBP表達(dá)減弱,可能參與慢性酗酒的酒精性腦萎縮和酒精性腦病發(fā)生機(jī)制,并且構(gòu)成慢性酗酒的TSAH死亡機(jī)制的物質(zhì)基礎(chǔ)。
[Abstract]:Background and Purpose


Traumatic subarachnoid hemorrhage ( TSAH ) is a kind of independent subarachnoid hemorrhage which is different from the subarachnoid hemorrhage and pathological subarachnoid hemorrhage due to brain contusion . It is related to the traumatic epidural hemorrhage and the inferior vena cava and is classified as three major traumatic intracranial lacunar hemorrhage . The research of the occurrence and death mechanism of TSAH is seldom seen at home and abroad . Therefore , the research and interpretation of the occurrence and death mechanism of TSAH related to acute and chronic alcoholism can provide scientific basis for the death cause analysis and the sentencing of judicial trial .


The TSAH model of acute and chronic alcoholism in rats was successfully established in the previous work of the study group . The results showed that the incidence and mortality of TSAH in rats with chronic cerebral concussion were 82.4 ? , 28.6 % in the acute group and 58.8 ? in the acute group .


On the basis of this , the relationship between the high mortality of TSAH and the changes of glial cells in rats with chronic alcohol intoxication was studied . The glial cell specific marker S - 100尾 , MBP , which was closely related to the functional structure of the central nervous fibers , was selected to investigate the expression of S - 100尾and MBP in brain tissue under acute and chronic alcoholism , and its correlation with the death mechanism of TSAH in rats .


Materials and Methods


1 Animal model and grouping


Sixty - one SPF adult male SD rats weighing 300 鹵 50g were randomly divided into two weeks .


1.1 Model of acute alcohol filling


28 rats were randomly divided into 4 groups randomly divided into acute pure alcohol group , acute alcohol infusion group , acute simple irrigation group and irrigation control group .


1.2 Model of chronic drinking wine


Thirty - three rats were randomly divided into four groups : chronic simple alcohol - infused group ( 7 ) , chronic alcohol ( n = 19 ) , group 4 ( death group , survival group 9 , survival group ) . Each group was given a dose of 8 ml / kg twice a day . After 2 weeks of administration , the rats were given a dose of 8 ml / kg twice a day . After the last two weeks , the rats were given a dose of 8 ml / kg . After the last two weeks , the rats were given a dose of 12 ml / kg . After the last time , the rats were given a dose of 12 ml / kg . After the last time , the rats were given a concussion . After the last time , the rats were given a concussion .


2 Method


All the data were analyzed by SPSS 15.0 statistical software , t - test and single - factor variance , chi - square test and statistical analysis .


Results


Behavior and BAC changes in rats with acute and chronic alcoholism


After drinking , the activity of the rats was increased , and the activity decreased , the activity decreased , the gait was unstable , the action was awkward , the blood pressure was 14.13 鹵 0.34 Kpa , and the blood pressure before the infusion was 17.02 鹵 0.88 Kpa ( P0.01 ) .


Compared with the acute group , the average weight was 251.8 鹵 19.6g , which was significantly higher than that in the acute group ( P 0.01 ) , the blood pressure was 18 . 16 鹵 0 . 82Kpa , the average age of the last time was 2 h , the BAC was 201.50 鹵 32.35 mg / dL above the acute group .


2 . Incidence , mortality and pathology of TSAH


The incidence of TSAH in the control group was 28.6 % , there was no death . The incidence of TSAH in the treatment group was 84.2 % , the mortality rate was 52.6 % , the incidence of TSAH in the treatment group was 71.4 % , the mortality rate was 28.6 % , and the mortality rate was significantly different from the control group ( P0.01 ) .


In the acute irrigation group , the surface of the brain was smooth , the surface of the brain was pale , the frontal lobe and the cerebellum surface of the acute pure irrigation group had a large amount of blood stasis , the brain surface of the rats with TSAH in the acute irrigation group and the back side of the brain stem and the lamellar thin layer SAH on the ventral side of the brain , and the SAH of the whole brain of the rats with the TSAH in the treatment group of the chronic alcohol infusion set the weight of the ventral surface of the brain stem .


histological examination , mild water degeneration of cranial nerve element and glial cell in acute alcohol infusion group , mild enlargement of that peripheral space of the cell , the decrease of the number of neurons in the brain cortex , the reduction of the numb of neurons in the brain cortex , the reduction of the number of nuclei , the reduction of the nucleus , the deep dyeing of the nucleus , the partial dissolution and disappearance of the nucleus , the deep - staining of the cytoplasm of the cytoplasm , the dark cell of the nuclear fixation , and the SAH of the thick layer of the brain stem , forehead , cerebellum and the like .


The myelin sheath of the acute irrigation group was slightly loose , the gap was enlarged , the color was slightly different , the brain stem was obviously irregular , thickened and twisted , and the broken nerve fibers were obviously enlarged .


Expression of 3 S - 100 尾 protein and MBP


3.1 S - 100尾protein positive cell count


The number of S - 100尾 - positive cells in each brain area was significantly higher than that in the control group ( P0.05 ) , but there was no significant difference between the two groups ( P0.05 ) .


The number of positive cells in each brain area was significantly higher than that in the control group ( P0.05 ) , and the number of positive cells in each brain area was more than that of the acute pure alcohol and acute pure irrigation group ( P0.05 ) . There was no significant difference between the treatment group and the acute irrigation group ( P0.05 ) .


3.2 S - 100尾 Protein IOD Value


The values of S - 100 尾 IOD in the brain areas of the acute irrigation group and the control group were higher than those in the acute pure irrigation group and the acute pure irrigation group ( P0.05 ) . There was no statistical difference between the control group and the simple group ( P0.05 ) .


The IOD value of the chronic alcohol - infused group was higher than that in other chronic alcohol groups ( P0.05 ) , and the IOD value was significantly lower in the treatment group than in the other groups ( P0.05 ) , and there was no significant difference between the survival group and the survival group ( P0.05 ) .


There was no significant difference between the values of IOD in the group of acute alcohol and the control group ( P0.05 ) , which was higher than that in the acute and acute irrigation groups ( P0.05 ) .


3.3 MBF D value


The values of MBP IOD in brain stem and corpus callosal were significantly lower than those in the control group ( P0.05 ) , but there was no significant difference between the groups ( P0.05 ) .


There was no significant difference in MBP IOD ( P0.05 ) between the two groups ( P0.05 ) . There was no significant difference between the survival group and the survival group ( P0.05 ) . Except for the chronic simple alcohol infusion group and the acute attack group , the MBP IOD value of the brain regions was lower than that in the acute group ( P0.05 ) .


Conclusion


1 . The acute and chronic alcoholism can be combined with cerebral concussion to blow up TSAH , and chronic alcoholism is an important factor in TSAH death .


2 . The expression of S - 100尾 protein in the glial cells of chronic alcoholism brain increased , the expression of MBP in nerve fibers decreased , the mechanism of alcoholic brain atrophy and alcoholic encephalopathy could be involved in chronic alcoholism , and the material basis of the death mechanism of TSAH of chronic alcoholism .
【學(xué)位授予單位】：汕頭大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：D919.1

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